The Northern Territory News reports that veteran euthanasia campaigner Dr Philip Nitschke faces a five-day hearing before the Medical Board starting today. Nitschke’s arguments will include:
Mr Nitschke says suicide is a lawful activity and the appeal was a question of whether rational adults should have access to information to help them proceed.
I wrote quite a long article a couple of weeks ago about euthanasia and Phil Nitschke. Someone on that thread remarked that Nitschke gave them the creeps.
Other people have said similar things to me in the past. I don’t really understand why. Certainly Nitschke is an intense, determined and even obsessive personality. But the same would almost certainly be true of just about any crusader for any cause. You need to have those qualities to maintain focus on such a difficult issue, involving intense emotions and huge end of life questions, over such a long period of time.
As I made clear in my previous article, I don’t agree with every single aspect of Phil Nitschke’s position on euthanasia. I certainly don’t agree that it should be lawful for any person, doctor or otherwise, to assist a person to commit suicide who has neither a terminal illness nor a chronic, incurable and painful medical condition. However, it needs to be kept in mind that Nitschke did not assist Nigel Brayley to commit suicide. He merely provided information about euthanasia options. It still raises difficult ethical issues about whether a doctor owes a duty of care to satisfy himself about a person’s state of mind before providing such information, and no doubt that is the principal issue that the Medical Board will be determining.
In that respect the Medical Board’s decision and reasoning will be very important for the future of euthanasia in this country. If the Board decides that a doctor does have a duty of care to satisfy himself about the state of mind of any euthanasia enquirer, that would effectively make it impossible for any one of us to access reliable medical information about euthanasia options without submitting ourselves to an invasive, distressing and deeply offensive full psychological assessment. In my view everyone (unless clearly suffering a significant mental illness) should have a right to such information, and doctors should have no right to suppress it.
With people today living longer and longer, these ethical dilemmas surrounding end of life decisions will inevitably become more frequent and more acute. We can’t keep fobbing them off and just leaving it to doctors’ disciplinary bodies to decide. Parliaments need to develop some intestinal fortitude, stop worrying about the reactions of a small minority of religious zealots, and enact appropriate legislation along the lines of the Northern Territory’s Rights of the Terminally Ill Act.
I regard Phil Nitschke as a great man and a modern day hero, and I wish him every success in his joust with the Medical Board.
He didn’t assist Brayley but merely provided information. This is a contradiction Ken.
A very blatant one in fact.
You regard him as a great man . Sorry I see him as an evil one.
The sooner this bloke is no longer a doctor the better.
Ken, it is of course the thing you “don’t agree with” that creeps people out about him.
Forget about him being a doctor, how would you feel about any person who had contact with one of your relatives enquiring about the best and least painful way to top themselves, and then (when the suicide happens) shrugs their shoulders and says “hey, don’t blame me – I was just providing information and who am I to recommend or suggest psychological help instead?”.
I would view any person who has done that has acted with no regard to ethics or common sense, let alone a doctor, who is supposed to have experience with helping people undergoing psychological pain, not just physical.
Of course he should not be allowed to continue to be a doctor. His death embracing career, and completely cavalier attitude as to why people may want to commit suicide, can continue in a “civilian” capacity.
I think there are clear problems with defining as professional misconduct the giving of information by a doctor about medical matters which could be used by a patient to kill themselves (even though killing themselves isn’t in fact unlawful). Contrary to Homer’s assertion, I think there is a perfectly reasonable and logical distinction between the giving of information and actively assisting a person to die e.g. by prescribing or giving the medication.
In a broader sense, I think there is a major conceptual problem with proscribing the giving of information in general. There are obvious situations where it is perfectly reasonable to prohibit the giving of particular sorts of information e.g. information about how to construct a nuclear weapon. However, when it is information about a medication which can be used to do something which is not unlawful (i.e. commit suicide) I think that is much more problematic.
To answer your hypothetical question, I’m sure I would be fairly distressed if I found out after the event that a doctor had given information to a close family member which they had used to kill themselves. However, I hope I would be able to think it through and reach a mature conclusion. At the end of the day the decision to commit suicide has been made by an adult human being who had every right to do so. If they were obviously mentally ill it might be different. However it hasn’t been asserted that that was the case with Brayley as far as I know. If you take the position that it is never ethical for a doctor to give such information to a person just in case they might be mentally ill, then as I said in the primary post you create a situation where no one can ever get reliable medical information about an end of life decision they have every legal (and moral) right to make without subjecting themselves to an invasive and distressing psychological assessment.
Let’s look at it even more broadly. Would it be unethical for me as a lawyer to provide information to people about psychological defences to murder e.g. the defence of diminished responsibility that is available in some states and territories? After all, a member of my audience might use that information to murder someone and get away with it. I actually gave an online lecture to my students on this very subject only a couple of weeks ago, and I wrote a long post on the subject here at Club Troppo some years ago. If someone uses that information to murder someone and get off with two years in prison for manslaughter because of alleged diminished responsibility (because they shopped around for a psychologist willing to say that they suffered from a mental illness), should I then be subject to disciplinary action for professional misconduct for disseminating this information without taking reasonable steps to satisfy myself that none of my audience had murderous intentions?
No there isn’t. If you tell a person what they have to do then you are quite clearly assisting them to kill themself.
I’m not sure why you are even arguing with this.
Ken, I think you’re engaging in slippery slope arguments here of at least as great a magnitude as some on the anti-euthanasia side.
Your example of a lecture about diminished responsibility may well be of questionable ethics if it were being delivered to, say, a meeting organised for a local Hells Angels Club after a raid over a recent spate of bikie related murders. A lecture given to a public audience in which one bikie attends after seeing it advertised would be a different thing entirely.
The difference in this case is also that Bayley did not just attend an Exit lecture, but was in direct email communication with PN. I see from an Exit media release that Bayley wrote to PN:
Now, while I can imagine that Dr N may be happy to rely on the sentence about Bayley having sought “medical and other forms of assistance” as indicating that it wasn’t worth recommending he try something else, by the time you get to the last sentence (and earlier on), it just sounds so obviously like the typical rationalisation of the depressed (but physically healthy) – that they are contemplating suicide in order to not be a burden on a loved one, emotionally and financially.
The problem with PN is that he appears far, far too ready to routinely assume that a person has made a rational decision about suicide, and that this means the suicide is indeed justified (for want of a better word). But it is common knowledge that suicidal people suffering from entirely treatable depression routinely adopt a cloak of “rationality” for their decision.
The reality is, of course, that thousands of people, having received appropriate treatment, can see the problem with their former “rational” thinking, and are glad someone urged them to get the help that worked.
This is why so many people think PN’s judgement is so badly lacking, and to such a serious degree that it is not how a doctor should act.
If you have concerns that this is discussing his case in too much detail given his current tribunal hearings, feel free to delete.
Sub judice doesn’t apply to tribunal hearings. Moreover the rationale even in courts is the possibility of prejudicing a jury. There are no juries in the Medical Board and I’m sure its members are entirely capable of disregarding our discussion if they stumbled across it.
On the substantive issue, I said from the outset that I am uneasy about Nitschke’s position on cases not involving fatal or chronic, incurable and painful conditions e.g. Brayley. I am also uneasy about the possibility of a doctor giving euthanasia advice to someone suffering clinical depression and therefore not in a position to make a proper, informed decision. However, I am even more uneasy about imposing a rule which would mean that doctors could never give advice about euthanasia options without facing disciplinary action, unless they insisted that the person seeking advice obtained a psychological assessment first.
The bottom line is that I think Nitschke may warrant a reprimand for his conduct in the Brayley case but not striking off.
Of course, none of these problems would exist if we had an act like the Rights of the Terminally Ill Act. It would set a clear framework with clear safeguards, and obviate the possibility of a Phil Nitschke operating on their personal moral principles because there are no authoritative guidelines on which to draw. I regard Nitschke as a courageous and praiseworthy person because he has refused to be cowed and intimidated by the conservative medical establishment which refuses to be honest about the compelling case for euthanasia in many circumstances, but instead is happy to hide behind the dishonest pretext of “double effect”.
By the way, I have also read how other euthanasia reform advocates have long seen his extreme views as counterproductive to the cause. I certainly can understand why. Am surprised you can’t see that.
If I try to use what reason I have on these kinds of debates, I end up where Peter Singer is. I guess these were my views when I was a kid. If there’s no difference between the capabilities of someone with human form and some dumb animal, what’s the deal with them having more rights. It’s in the face of that that these days I back off and simply suspend judgement – either way I might say. It’s not something about which I feel very comfortable with strident views (though I can understand the stridency of those arguing for the right to die of those who are terminal and in great pain.)
My mum turned 92 ten days ago. In a home.
About 18 months ago, I’d visit her and, though she had bad dementia, could not hold any kind of conversation or really utter a sentence that made sense, her eyes lit up with pleasure and love when she saw me on my way to visit her across the room.
Today she doesn’t recognise me. She simply exists. She sleeps most of the time. When I last saw her, she’d fallen out of bed (a safe thing to do as the bed is lowered to the floor). She was sleeping and was cradling a shoe in both hands – stretched out prayer-like – and occasionally moving it to her mouth.
What am I to make of this situation? I’m afraid I can’t make anything much of it. I find myself slipping into thinking about her in the past tense. She exists as a physical simulacrum of the person she once was. Beyond that, I have no idea how I should think of her.
I can’t help thinking that we’re all doing what we’re doing – the carers caring for her physical needs and me and family members paying for the home and visiting her – out of a kind of timidity. It doesn’t really make much sense to do these things. I can’t claim omniscience about this, so I could be wrong, but there is no sign that it does her any good. In a negative sense of course we care, or try to care as best we can for her physical needs because she can feel pain and we can alleviate that. Beyond that, those who visit her do it our of sentiment – rather than any clear understanding of her needs, and because we don’t’ want to feel badly about ourselves.
And as for keeping her alive? Well we don’t want to ‘play God’ as we say. She’s a simulacrum of who she was and we’re responding in kind with a simulacrum of care – which is now care for a body, for a memory. I have no clear views that there is a better way to behave, but I find it hard to have strong views about what the right thing to do is.
I understand why people who’ve only seen Nitschke in brief news grabs might find him creepy. He’s a pugnacious character, which in combination with an apparently brisk promotion of the right to choose death, appears cold, if not downright undoctorly. But encountered in person for a longer period, it’s quite obvious that he’s entirely aware of the delicate gravity of an individual’s death. He is by nature more of of a fighter (previously for aboriginal rights) than philosopher, so perhaps oversimplifies the issues, but doers like him are always needed somewhere in the social change mix.
I agree with your conclusion, Ken. When a conservative authorities diverge so far from evolving vernacular ethical beliefs and are determined to block change, it takes real courage for someone with a highly contingent professional standing to face up to them as Nitschke is doing.
yes, agreed as well.
The inability of parliaments to discuss such things rationally, and thus leaving it to doctors and nurses to make these decisions implicitly rather than explicitly, is a bit of a puzzle. As if by not discussing painful things they wont happen and we can all pretend life goes on forever in lala-land. This head-in-the-sand attitude is unfair on the doctors and nurses who are then forced to make the tough decisions and live in some legal limbo land.
What choice does Nitschke have in trying to maintain plausible deniability for his assistance with euthanasia? It’s quite obvious that he would actively be helping people to manage their end-of-life process if he were able, but that’s simply illegal, so he has to resort this crass legalism about whether providing information is the same as active involvement.
This discussion seems so old-fashioned, as though information on suicide is something hidden and known only to experts, instead of the focus of a thousand websites and discussion boards. Nitschke is one of the more sensible voices on this matter, advocating the option of effective euthanasia for the terminally ill, rather than untreated depressives with web handles guessing about plastic bags and Panadol for sad adolescents.
Without Nitschke Brayley would have no idea of how to commit suicide and succeed.
Case closed.
Dear Homer
Have you heard of an obscure facility called Google? Most people (except apparently you) use it these days when they want to find out something. Try Googling “nembutal” and “suicide” and see what you find.
If you hadn’t heard of Nembutal, you could just Google “suicide” and “drug”. On the very first page you would find an article from The Australian titled Suicide drug of choice in mail. It tells you about Nembutal and the fact you can get it legally in Mexico. It even gives you the name of a supplier. Perhaps Rupert should have his newspaper licence revoked?
Ken,
I do not have to I know what suicide is and what it entails for friends and family.
It is you that is hiding behind words. It isn’t your finest hour.
I do too, having had a friend of many years commit suicide.
Alone, because he could not have his friends around him.
In extreme pain, because the only meds that could ease it, so debilitated him.
A miserable death forced on him by religious bigots.
He could not make the choice of leaving with dignity because the self righteous judgemental turds of this world would not allow it.
His wife and the rest of us had to remain in ignorance, lest we be subjected to a police inquisition, and so she had to come home to find the body.
Frankly, it would have been better for everyone concerned had my friend contacted Dr Nitschke so that it would at least have been less messy for my friend’s wife.
Perhaps, just like with other social changes, those who wish them need to make more public statements and actions so that the uncaring or the unctuous can’t ignore them.
Exactly. The world is full of people contemplating suicide or ruminating on death either seriously or romantically, and they’re not at all shy about sharing their thoughts across the internet.
Scrutinising Nitschke’s ethics and motivations is completely valid, but to suggest that he is some purveyor of obscure and complex information on suicide is breathtakingly ignorant.
So Sanchez you believe Brayley had all the information to kill himself whilst in the prime of his life without Nitschke’s help.
So presumably he was asking him how to make a cup of tea?
At the very least Nitschke should have done a due diligence on the man and he has readily admitted in the media he didn’t. He claimed Brayley was of a sound mind and making a rational decision!
whoopsy Sancho definitely not Sanchez
With all the enthusiasm for legal euthanasia, I might add a side observation.
I doubt it’s going to help much with the expected rise in the number of elderly suffering dementia. My own mother, who died earlier this year, used to say from her 60’s what a lot of aging people do – that it would be good if she could just take a pill to put her to permanent sleep if she felt she was becoming, or about to become, a burden. But she went on to live independently, and happily, until about age 86, when gradual signs of coming dementia started appearing, which worsened over the space of a year or two, until she had to go into aged care. All but one or two of the residents there were obviously not in any state to be making sound judgement about euthanasia.
But the thing is, once we felt certain that it was dementia on its way (due to some clearly odd behaviour and things said, and medical assessment done) I don’t think anyone could feel confident that she was then able to make a very rational decision about ending her life. There may be a period in which there is awareness that they are “losing it”, but gee, its hard to know whether that is just really part of general confusion, or that it is really their rational part of their mind seeing what’s going on.
So for the one of the biggest concerns that people have, I don’t see legal euthanasia helping much; at least if you are of the view that would not be a desirable system to allow relatives to make the call as to when the pill is to be administered to a conscious person.
There is generally a time after dementia is diagnosed when doctors are still able to certify that the person in question has mental capacity to make decisions. Both my dad (who died early this year) and my mum (who is still alive in the high care area of a nursing home on Sydney’s northern beaches) had/have dementia. My mum’s mother also had it. It runs in the family, so there’s a fair chance I will end up losing my marbles one of these days. Hence I have a very personal interest in the subject. Neither my mum nor my dad ever expressed a wish for assisted suicide at any point, but that certainly isn’t my position. I want to be able to end my life in a dignified manner at a time and place of my choosing when I feel myself slipping too far.
Three or four years ago when we became clearly aware that both our parents were on the dementia slide, we contacted solicitors and doctors because they needed to do new wills, appointments of adult guardian et cetera. The doctors were able to certify that they had the requisite mental capacity, and they clearly did. Both knew and understood exactly what they were doing at that time, and also understood that they might not stay in that position for all that much longer.
I agree that Dr Nitschke’s position, on not having a duty of care to satisfy himself about the mental capacity of someone to whom he gives euthanasia advice, is troubling. But, as I said, I also don’t think the inherently dishonest position of the medical profession is satisfactory either. Nor is the position of religious people like Kevin Andrews (presumably including Homer) who think they have the right to impose their own religious/moral views on others. You just don’t, and opinion polling consistently shows that the great majority of Australians agree with me.
BTW I am going to post my eulogy to my dad from early this year as a post here at Troppo. It might be a bit self-indulgent, but hopefully some might find it worth reading.
so Ken has the right to impose his views on everybody but others are not allowed.
Say no more
Homer, your position is utterly illogical (and typical of the dogmatically religious). I would not impose my moral views on you. If you think that suicide is always wrong, and that assisted suicide is also always wrong, then do not participate in them. But you have no right to stop others from exercising their own freedom of conscience. I hesitate to label such a position “evil”, but to be blunt that’s what I think it is. There is clearly no point in discussing the topic with you, so I will ignore any further comments.
That’s al right Ken I am ignoring your illogical comments anyway but impose your views at will
I know there are some people (I would think, more likely, those with relatively early onset Alzheimers) who understand the diagnosis and what lies ahead. In my mother’s case, where it was late onset and a case of the family becoming increasingly concerned about her behaviour, it was never clear that there insight on her part; just increasing confusion, and a resistance to receiving assistance via medication or home care.
I think for many cases, the mere fact that there is some dementia would give a lot of children discomfit as to whether their parent was thinking clearly at the time they decided to end it.
This is not being put as a compelling reason to be against legalised euthanasia per se; just a caution against people thinking that legalising it would necessarily reduce old age related suffering by a large amount in the general population.
Ken, I saw Barry Cohen on 7.30 last night, and he certainly fitted within the category of a person with a diagnosis of early dementia who still had clear insight of his condition and future prospects.
But nonetheless, his capacities at this time seemed so strong that I thought his family would likely very much regret his opting to take euthanasia now. That’s the problem here – until people have advanced far enough down the track of dementia, euthanasia seems premature. Once they have reached the point where it appears to everyone it isn’t premature, they have lost capacity for rational decision, and letting the relatives make the call as to the point at which it can be administered could be very messy in many respects.
My mother died some years ago of ovarian cancer. The cancer was fairly aggressive, but she was on morphine and experienced little/ no pain.
In her last months, she sat me bedside and said that if the good nurses who administer the morphine (administered by 2 nurses, 1 as witness) made a silly arithmetic error and moved the decimal point 1 or 2 places to the right, tell them not to worry. She was lucid and was aware of what she had said.
I mentioned the conversation to her oncologist, who told me that he receives 3 of these request every day. He also said he was not totally adverse to the requests. The hospital was a veterans hospital and the patients were there to die. The vast majority wanted a painless, quick death rather than a prolonged and wretched affair. Almost all patients had prepared themselves, some saying they had made peace with their Maker and themselves.
But the oncologist he said he was at the top of his profession and could not risk detection concerning assistance with euthanasia. He did not want to go home and tell his family and colleagues he had been charged with murder.
He advised that the nurses sometimes, with a wink and a nod, do make arithmetic mistakes, and he was was aware of that practice without direct knowledge.
But generally the whole subject was not spoken about in the hospital for fear of listening devices.
Steve my mother was a trained nurse , she used to talk a lot about the fact that people with dementia in care, are regularly given the vaccine against pneumonia. Pneumonia was once a common cause of death in the old, Mum used to say that nurses used to call pneumonia ‘the old persons friend’. It would be good If we did less of mindlessly dragging out, dying .
Captain of the men of death, the old man’s friend. Dying from pneumonia seems to be a lot more pleasant than dying of other things.
What palliative care can’t do is grant dying with dignity. If I discover that I have a glioblastoma multiforme, there will be a day that I invite my friends and family over to say goodbye, then wander off into the bushes with some lignocaine and a sharp knife. I have no desire to lose my personality and my mind to an intracranial malignancy, to linger on for months after that.
Back on topic: AHPRA has precedent for viewing statements made outside a doctor-patient relationship as being potentially unsatisfactory professional conduct or professional misconduct (see Jereth Kok’s facebook comments). I think Dr N should be admonished, conditions placed on his registration, but not struck off.
yep, been there done that.
Well said
Fairfax reports this morning that:
It looks like this might have been quite a timely blog post. You can find the Committee’s report here. I was particularly interested in what the Committee found about the constitutional underpinning for a national medical euthanasia law, because I have significant doubts whether the Commonwealth could successfully legislate such a law. The Committee found (starting at page 15 of its report), albeit not without considerable hesitation, that the Bill would be supported by section 51(xxiiA) of the Australian Constitution (provision of medical and dental services etc). It also found that the Bill could be partially supported by the corporations power (to the extent that doctors were employed by corporations) and the territories power (which is effectively just about unlimited in extent). However, the Committee’s report had a sting in the tail for doctors, given that its conclusion that the Bill is constitutional is quite tentative and that it accepts that there would certainly be a constitutional challenge if it were passed:
Dying with dignity had nothing to do with this, Brayley was in the prime of his life.
The is the major point Ken keeps on evading. It was suicide not dying with dignity
If I am to apply my reason to these questions, I end up not far from where Peter Singer is. It’s in the light of that that I pull back. I’m not God and don’t feel comfortable having strong views about any of this.
As a practical matter, my mother just turned 92 and is completely incoherent with dementia. About 18 months ago, she was similar, but when I went to visit her, her eyes lit up with pleasure and recognition.
Today she doesn’t have the slightest idea who I am. She’s not in pain, and so it’s not particularly cruel keeping her alive. But I can’t help thinking that the only reason we’re all keeping her alive is that we’re all morally scared of ‘playing God’ as they say – of taking the ultimate responsibility of life or death over another person’s life. Thing is I often catch myself reaching for the past tense in speaking of her. As a person, as the person who loved me, she’s well and truly gone – and present as a physical simulacrum.
Nicholas,
Modern medicine is playing God. We can cure diseases now that would have been a death sentence 100, 50, or even 20 years ago. So I don’t think that my making a difficult decision, you are playing God.
I don’t know if you are the ‘person responsible’ for your mother, but if you are, the next time you are asked to consent to a treatment, perhaps you should ask the doctor what the goals of treatment are. I often wonder what my colleagues are thinking when they put 95yo demented nursing home residents on medications that will reduce the risk of stroke or heart attack by 5% in the next year. I would think that a heart attack is a kindness in that situation.